I loooooove biceps brachii. You too? Well read on!
Biceps brachii is a beauty. He makes his home in the land of anterior humerus and traverses across glenohumeral, humeroulnar and humeroradial. He's a bit indecisive in the genohumeral regions so he makes a big split to cover more ground. This is where it gets interesting!
The proximal portion of biceps brachii splits into a short head and a long head. The tendons of each, attaching at different locations around the shoulder. For this article, I will be exploring the amazing anatomy of the long head.
The long head of biceps brachii has so many relationships around the shoulder. It's these relationships that allow for a balance between mobility and stability in the shoulder joint. When this delicate balance is compromised, however, the result can be pain and dysfunction that affects the shoulder girdle, neck and beyond. If you have a client or patient with symptoms of LH trauma, think beyond just the tendon. It is likely not the only player in the dysfunction. If you are a patient, and your therapist is only treating your tendon, send them to this blog post.
But wait, there's more!
As if biceps brachii isn't cool enough, it is also credited with the assignment of the word muscle to all those neatly arrange bundles all over our body containing actin and myosin, all contractile and stuff, and allowing us to move. Yes. It's true. The word muscle comes from the Latin musculus, "a muscle", which is formed by the word mus, or "mouse". Muscles were called such because the shape and movement of some muscles, most notably biceps brachii, were said to resemble mice. As wicked awesome as this is, I can't see "gun show" being replaced by "mouse frolic" at your local gym any time soon.
So, in honour of biceps brachii, this #flexfriday dedicate the flex to your #armmice
Andrews JR, Carson WG, McLeod WD. Glenoid Labrum Tears Related to the Long Head of the Biceps. Am J Sports Med 1985.
Khazzam, M, George M.S., Churchill S, Kuhn, J.E. Disorders of the long head of biceps tendon. J Shoulder Elbow Surgery 2011; doi:10.1016/j.jse.2011.07.016
Todd G.K., Bell D, Goldberg J, Wade H, Pelletier M, Yu Y, William W.R. Anatomic and Biomechanical Study of the Biceps Vinculum, a Structure Within the Biceps Sheath. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2009.
Tuoheti Y, Itoi E, Minagawa H, Yamamoto N, Saito H, Seki N, et al. Attachment types of the long head of the biceps tendon to the glenoid labrum and their relationships with the glenohumeral ligaments. Arthroscopy 2005; doi:10.1016/j.arthro.2005.07.006
Weishaupt D, Zanetti M, Tanner A, Gerber C, Hodler J. Lesions of the Reflection Pulley of the Long Biceps Tendon: MR Arthrographic Findings. Investigative Radiology 1999.
Werner A, Mueller T, Boehm D, Gohlke F. The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval: a histo-anatomic study. Am J Sports Med 2000.
"Don't worry about me. Do what you've gotta do"
"I know it will feel better in a few days"
"No pain, no gain right?"
I probably hear comments like this at least a few times a day in my practice. Manual therapy has a dirty little secret. It has perpetuated this idea that a therapy has to hurt to work. This is a travesty. The International Association of the Study of Pain (IASP) defines pain as being associated with actual or potential tissue damage. Why are we liberally assigning therapeutic value to causing our clients pain?
As a brand new massage therapist, I also subscribed to this terrible principle. My education and the industry put a bigger premium on therapists who could perform aggressive, deep, "painful" techniques. Some clinics even charged more for it. This was viewed as somehow more effective than what people labelled "fluffy" massage. The flip side of this is that therapists who could not exert huge amounts of force were sometimes made to feel inferior. In my youthful ignorance, I jammed elbows and thumbs into the ailing soft tissues of many many people. They spent a couple days after the treatment feeling bruised and beaten, and came back for more a few weeks later. I thought this meant I was good. I was wrong.
I'm not saying that deep techniques are bad. If you can handle it then more power to ya! It's all about tolerance. But no one should be convinced that they need to grit their teeth and bear pain beyond their tolerance in order to get better. Period.
So now lets talk truth. Truth is that pain is a manifestation of the nervous system NOT of the soft tissues (one day I will write more about this). Manual therapy has this amazing ability to moderate pain but it can't be done by damaging tissue. Seems obvious. We need to view stretching, manual therapy and the like from a bit of a different lens. If we look at it from the perspective of a type of altering of the nervous system, stretching becomes less vigorous and forced, massage manipulations become slower and less painful and our view of how we approach pain manifesting in tissues gets turned upside down.
If you are a manual therapist, it is your responsibility to do your due diligence. Read more. Questions more. Learn how to investigate and critique the current literature around manual therapy. Do not continue to accept the antiquated ideas and concepts that are still, unfortunately, taught in our schools. Drop the dogma!
Need a starting point? Investigate the most recent science behind the use of ice to improve healing. You might be surprised at what you find.
Laurie Di Giulio
Aspiring Jedi therapist, lover of the art in human anatomy, reveler in the miraculousness of life.